Separation Anxiety Disorder

 Psychological disorders in children can be as a result of physiological or genetic components and at times both of the components can be observed during the diagnosis. There are other disorders which occur in children and never seem to be caused by any physical effect, but instead, they are caused by problems of physiology and biology perspectives and are more likely to be detected in early stages of life. Search disorders include mental retardation, communication skills disorders, learning disorders among others. These types of disorders are always identified early in life with the exceptions of a few which can be identified later in the adulthood stage. Some of these disorders from another perspective contribute to other disorders which only manifest when the child is in the middle stages of growth. One disorder affiliated with mental retardation is separation anxiety disorder (SAD) which is defined as a state of excess tension that arises when a child is isolated from home or the family breadwinner. This paper intends to give more insights into the separation anxiety disorder from the perspectives of DSM 5 criteria for the disorder and the risk factors associated with the disorder which contributes to depression.

Separation anxiety disorder occurs in children between 3 and 4 years old and becomes problematic to families during the elementary schooling of the child. The child develops an abnormal fear of the thought that something horrible may happen to her or the parent while she is not around. At times, the child responds to the circumstances leading to the separation through expressing anger to the adult and even crying in an attempt to manipulate the situation to her favor. As the fact remains that schooling is inevitable, the child is compelled to attend school, but with time, the child’s distress is displaced by other maladaptive forms of behavior. For example, the child may begin showing behavioral problems within the school setting or at home yet initially there were no such problems in the child (“Separation anxiety disorder – children, causes, DSM, functioning, therapy, adults, drug, examples”, 2016). This is caused by the child’s attempt to seek a new peer group only to unfortunately land in negative peer group hoping to get attention in the pursuit of solving the mysteries of separation.

The DSM 5 criteria for the disorder

Over the past few decades, the SAD criteria have been noticed to shift as research on its phenomenology continues to advance. Initially, the disorder was associated with DSM-3 based on a particular social situation contributing to specific phobia. The diagnostic criteria, however, underwent significant changes with the introduction of DSM-4 as it became clear that children who met criteria for social phobia experienced anxiety that manifested from different social situations. DSM-4 seemed to work proficiently but with the dissatisfaction that was experienced in the limitations of the nongeneralized and generalized SAD, Kerns, Comer, Pincus & Hofmann (2013) denote that there was a need to base the disorder in the DSM-5 with the future research about the disorder.

The American Psychiatric Association (2013) points out that there is a total of about nine diagnostic criteria for SAD with special reference to DSM-5. They include:

The anxiety that relates to different kinds of social settings in which a child feels someone is observing and scrutinizing him. This occurs in settings that involve peer and will be exhibited with respect to particular age involving actions such as lacrimation, flinching or to some extent expressing some level of discomfort.
Individuals will show fear towards experiencing their anxiety which would lead to rejection from a social platform.
There will be consistency in provoking distress caused by social interaction.
There is a high avoidance of social interactions as the child views it as painful or something that involves endurance.
There will be disproportionate to the actual situation grossly caused by fear and anxiety.
The disorder will persist for four weeks around social circumstances.
Impairment of functioning in various domains is experienced in a form of personal distress.
The anxiety cannot be affiliated with a medical disorder, use of a substance or adverse effects of medication or another mental disorder.
In the presentation of another medical condition which may lead to an individual being excessively self-conscious, the clinician may be prompted to include a more specific form of social anxiety determined by performance situation such as oral presentations.

Risk factors

The risk factors associated with this disorder can broadly be looked at from the perspectives of two broad categories namely environmental risk factors and the biological risk factors. Dabkowska & Dabkowska-Mika (2015) argue that SAD is a complex interplay that combines the vulnerabilities that arise as a result of biological factors, environmental influences, and parental psychopathology among other factors.  Numerous factors are under the two broad categories of biology and environment, but this paper will only lay its focal point on three forms of risk factors.

Parental loss

This has been affiliated with different kinds of psychopathologic characteristics. Kendler (2001) reports that several studies have managed to assess the relations between the loss of a parent at an early stage of growth and psychopathology in adults for 1018 pairs of different kinds of twins with female characteristic. The study showed that there is an impact that leads to anxiety in case of a parent loss. From another perspective, parental separation from the child can be viewed as a parental loss. Parental death and divorce have shown anxiety disorders. Parental death can lead to higher development of social phobia especially where the death is of the mother rather than the father (Kendler, 2001).

Sexual abuse.

Sometimes children grow in an environment where there is a higher level of moral decadence within the society. For instance, research done in New Zealand children depicted that children who reported sexual abuses had greater levels of separation anxiety disorder compared to those who never reported (Fergusson, Horwood & Lynskey, 2006). Sexual abuse in childhood has been discovered to escalate the vulnerability for panic disorders and GAD in adults together with other mental and use of substances disorders. In a nutshell, sexual abuse that is based on self-reporting has positively been associated with almost all the disorders.

Parental factors

This is an aspect of genetic factor, where infants who seem to be anxiously attached in infancy develop more anxiety during childhood compared to the infants who were securely attached. Parents who were affected by anxiety disorders generally cannot manage the anxiety in their children effectively as they lack the abilities to discharge adequately such a service. Hirshfeld-Becker & Biederman (2002) point out that such children develop anxiety disorders more frequently and at times it happens at tenders ages of growth probably in toddlerhood. The offsprings of the parents who had anxiety also manifest the same kind of anxiety the parent had. Parental psychopathology and the rearing of children are always affiliated with offspring social phobia. Observations have managed to show that there is continuity in the grading of the relationship between the risk factors that arise from within a family setting and the SAD portrayed by an offspring (Knappe, Beesdo, Fehm, Lieb & Wittchen, 2008; Knappe et al., 2009).

Mediation factor

The above risk factors discussed are just but a few of the one available regarding separation anxiety disorder. The question that remains ringing the mind is whether there are mediation factors that can help children cope up with the harsh situations they undergo as a result of the risk factors. Taking for example parent loss as a risk factor, children who fall victims of such a factor can be helped by being encouraged to join children psychoeducational groups which can assist in the provision of powerful support, the opportunity to express emotions and education about loss. This would encourage them in a way that would show them that they can effectively cope with the massive anxiety changes they undergo. Children can involve in storytelling sessions, play games or indulge in more structured activities that would help realize the mind they need for forward propulsion (Moody & Moody, 2003; Zambelli & DeRosa, 2000).

Conclusively, separation anxiety disorder possesses a strong risk for a situation of recurrent disorders of anxiety from children to adulthood. If proper care is not taken to address the issue then in future the children as they enter adolescent stage would suffer depression, dependence on illicit drug and even end up with underachievement in the education as young adults. Clinical practitioners have a role to play in terms of providing avoidance and survival techniques as well as providing prediction techniques that would detect unfavorable course of anxiety. Having sufficient knowledge of the risk factors that cause SAD would, therefore, enable preventive actions with respect to developing anxiety in children. Having a substantial knowledge would call for effective mediation techniques in the pursuit of building resilience in the children as far as anxiety related actions are concerned. Therefore, more emphasis should be put on striking the iron while still hot to save the worse situations that would arise in adulthood as a result of high anxiety levels that were never controlled at childhood.

 

References

American Psychiatric Association, (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Association.

Dabkowska, M., & Dabkowska-Mika, A. (2015). Risk Factors for Anxiety Disorders in Children. A Fresh Look at Anxiety Disorders. http://dx.doi.org/10.5772/61169

FERGUSSON, D., HORWOOD, L., & LYNSKEY, M. (2006). Childhood Sexual Abuse and Psychiatric Disorder in Young Adulthood: II. Psychiatric Outcomes of Childhood Sexual Abuse. Journal of The American Academy of Child & Adolescent Psychiatry, 35(10), 1365-1374. http://dx.doi.org/10.1097/00004583-199610000-00024

Hirshfeld-Becker, D., & Biederman, J. (2002). Rationale and principles for early intervention with young children at risk for anxiety disorders. Clinical Child and Family Psychology Review, 5(3), 161-172. http://dx.doi.org/10.1023/a:1019687531040

Kendler, K. (2001). Childhood Parental Loss and Adult Psychopathology in Women. Arch Gen Psychiatry, 49(2), 109. http://dx.doi.org/10.1001/archpsyc.1992.01820020029004

Kerns, C., Comer, J., Pincus, D., & Hofmann, S. (2013). EVALUATION OF THE PROPOSED SOCIAL ANXIETY DISORDER SPECIFIER CHANGE FOR DSM-5 IN A TREATMENT-SEEKING SAMPLE OF ANXIOUS YOUTH. Depression and Anxiety, 30(8), 709-715. http://dx.doi.org/10.1002/da.22067

Knappe, S., Beesdo, K., Fehm, L., Lieb, R., & Wittchen, H. (2008). Associations of familial risk factors with social fears and social phobia: evidence for the continuum hypothesis in social anxiety disorder? Journal of Neural Transmission, 116(6), 639-648. http://dx.doi.org/10.1007/s00702-008-0118-4

Knappe, S., Lieb, R., Beesdo, K., Fehm, L., Ping Low, N., Gloster, A., & Wittchen, H. (2009). The role of parental psychopathology and family environment for social phobia in the first three decades of life. Depression and Anxiety, 26(4), 363-370. http://dx.doi.org/10.1002/da.20527

Moody, R., & Moody, C. (2003). A family perspective: Helping children acknowledge and express grief following the death of a parent. Death Studies, 15(6), 587-602. http://dx.doi.org/10.1080/07481189108252547

Separation anxiety disorder – children, causes, DSM, functioning, therapy, adults, drug, examples. (2016). Minddisorders.com. Retrieved 19 March 2016, from http://www.minddisorders.com/Py-Z/Separation-anxiety-disorder.html

Zambelli, G., & DeRosa, A. (2000). Bereavement support groups for school-age children: Theory, intervention, and case example. American Journal of Orthopsychiatry, 62(4), 484-493. http://dx.doi.org/10.1037/h0079386